The affect heuristic and conflicts of interest


Category : Medical Rants

Understanding the affect heuristic leads one to expand their understanding of the term “conflict of interest”. My simple explanation of the affect heuristic follows:

If you like something, you overestimate the benefits and underestimate the risk. The contrary holds also. If you dislike something, you underestimate the benefits and overestimate the risks.

This concept helps us understand that we should consider multiple conflicts of interest. Clearly the pharmaceutical and device industries have taken advantage of this concept. They hire very likable representatives. This representatives treat physicians very well. Physicians, nurses and office staff like the representatives. Thus, the companies are well considered. When considering a drug that they are selling or a device that they make, the recipients of the kindness attribute benefits and minimize risks for the drug or the device.

The same phenomenon occurs when the business funds research. The recipients of the research funds will have their values changed.

These values change subconsciously. We need not say that the conflict is explicit.

But there are other major conflicts. Our expertise is a conflict. For example, my thoughts about pharyngitis induce the affect heuristic. Being a diabetologist induces the heuristic. Diabetologists overestimate the value of tight control, and suppress the estimates of risks. Interventional cardiologists overestimate the benefits of stenting and underestimate the relative benefits of CABG.

Insurance company executives underestimate the benefits of expensive treatments.

The only logical way of avoiding conflicts of interest is to balance our committees and thereby balance the conflicts.

Most guideline writers and performance measurement developers would deny that they have a conflict. But we all have some conflict. We should acknowledge our conflicts and make them explicit.

We cannot avoid conflicts, thus we should consider the competing conflicts.

Comments (6)

What’s the root cause of affect heuristics? (probably too many things which influence our behaviors over time). Also, how should we address them internally – by consciously analyzing them or only with external checks and balances?

Check the link that I added to the post. That article explains the affect heuristic well.

Are certain kinds of conflicts more concerning than others? Specifically, is financial conflict something we should be even more concerned about than intellectual conflict?

Financial conflict always flow one way, wherever the money leads. Other conflicts can be all over the board and may represent diverse viewpoints that we would want to hear.

Do we want “whatever makes more money” represented? Should we strive to eliminate, rather than represent and accommodate, financial conflicts?

One could argue that most conflicts are financial. But all conflicts influence decision making implicitly.

To view doctors as a group who would cast aside the interests of their patients for a few slices of pizza is an affront to all those who’ve toiled for years, rendering one on one care in the best traditions of the healing arts. There has been an ongoing War on Doctors for years, yet many opinion leaders simply ignore the obvious, feeding Winston Churchill’s crocodile in the hope it will eat them last.

Please reread the post. The affect heuristic is not a conscious decision, not an obscene conflict of interest, but rather a natural psychology that impacts all humans, including physicians.

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